Edema?

  1. How do you tell edema from fat ankles?

    I have a lot of patients who have no pitting, but it looks like their ankles are swollen, but I suspect it is just like I said, fat ankles. I know their is a term called brawny edema, where the area is so edematous that it doesn't pit, yet there is edema present.

    Yes, I have asked the patient if their ankles are normally like that and it seems a lot obese can't see nor do they look at their ankles, so that doesn't help any. I really hate looking to see what the prevous shift charted because I want to know for myself. It's sometimes frustrating when my own perception differs from the others charting.
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  2. 6 Comments

  3. by   Antikigirl
    Okay...there is a simple thing you can do. Measure the ankles once a week and PRN and note the edema you feel is present (+1-4 and pitting or not) as well. If this changes all the sudden you will see a difference. Put it on the MAR (or have your RN do this) as part of the plan to see changes.

    I have had to do this on people with larger ankles and larger legs to get an accurate reading.

    And remember...assessessing edema by sight can vary, but actual measurements is the way to go! You may even see changes throughout the day and according to activity level. If it is well marked you have your norm after time and thought.
  4. by   Lisa CCU RN
    Quote from TriageRN_34
    Okay...there is a simple thing you can do. Measure the ankles once a week and PRN and note the edema you feel is present (+1-4 and pitting or not) as well. If this changes all the sudden you will see a difference. Put it on the MAR (or have your RN do this) as part of the plan to see changes.

    I have had to do this on people with larger ankles and larger legs to get an accurate reading.

    And remember...assessessing edema by sight can vary, but actual measurements is the way to go! You may even see changes throughout the day and according to activity level. If it is well marked you have your norm after time and thought.
    Thanks. This is a good idea if I were gonna be around for a while, but I am doing clinicals on a post op floor, so people are not around very long and I am only there one day a week.
  5. by   ATOgator10
    You can ask the patient something along the lines of, "are your ankles normally this big, or do you think your ankles are swelling??" Subjective data can give you clues on what is going on with the patient, though objective data is usually more reliable.
  6. by   Antikigirl
    Oh sweety...just do it for your own peace of mind in your own assessment and document it in the nurses notes. If no one sees it fine, but you did right by the patient for being concerned and being proactive enough to say something vs the others that don't!

    Your nurse goes over your documentation right..I would be giving you a big kudos if you did it..and I would actually remember it as being written down and could access it or follow up by doing it too! You never know...

    Good job on being a good assessor! It should never get routine, but personal like you have shown!

    And I totally agree with the above poster....ask the patient and document that in quotes...may not look like much, but to a keen eye it speaks volumes!

    Example...last night...I told an MD that the lady who was about to suprisingly crash (see "sometimes you have to go with your gut") that the patient said her onset of headache 10/10 was normal for the past month, and it hits hard and fast and she takes methadone for it. Okay the Doc dismissed me for 'downplaying' a possible stroke, but I wasn't...If the doc was keen she would have seen that this is a pattern and those poor arteries have been dealing with pressure for a month or longer and could actually blow (it is one thing to have a sudden onset, vs this occuring over time! It is very good assessment!!!!). Sure enough...those arteries were about to blow! Good thing I had that little piece of assessment documented, and the fact that my patient was alert and oriented enough to tell me (which also goes to speech, breathing, heartrate, liveable BP, brain is working, alertness, pain scale and history!!!!).
    Last edit by Antikigirl on Nov 8, '06
  7. by   leslie :-D
    measure their ankles in the dependent position, then have them elevate their legs, such as lying in bed.
    measure an hr later-any decrease will confirm edema.

    leslie
  8. by   Lisa CCU RN
    Quote from earle58
    measure their ankles in the dependent position, then have them elevate their legs, such as lying in bed.
    measure an hr later-any decrease will confirm edema.

    leslie
    This is a good idea too. Ok, I think I got it. I am on a post op floor and I am always "alert" for potential complications.

    Thanks.

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